Leaflet Resection Improves Valve Expansion and Hemodynamic Performance in Redo TAVI with Balloon- and Self-Expanding Valve-in-Valve Configurations

Redo transcatheter aortic valve implantation (redo-TAVI) is increasingly carried out to treat degenerated transcatheter heart valves. Residual calcified leaflet tissue from the first valve may impair second-valve expansion and thus prosthesis–patient mismatch and hemodynamic alterations. While leaflet laceration techniques mitigate coronary obstruction, the biomechanical impact of complete leaflet resection remains poorly understood. This study aims to evaluate the structural and hemodynamic effects of transcatheter leaflet resection in redo TAVI for different valve sizes and devices. Finite element and smoothed-particle hydrodynamics (SPH) simulations were performed on a patient-specific TAVI model. Redo-TAVI was simulated with and without leaflet resection using both the balloon-expandable Sapien 3 and self-expanding Evolut PRO devices under different valve-in-valve configurations. Expansion and eccentricity indices, effective orifice area (EOA), and mean pressure gradient (PG) were quantified. Leaflet resection consistently improved second-valve expansion and reduced eccentricity, particularly at the annular level. In size-matched balloon-expandable redo-TAVI, annular expansion increased by approximately 30% and eccentricity decreased by nearly 50%. In mismatched size configurations, eccentricity was reduced by more than 80%. Hemodynamic performance improved accordingly, with EOA increasing by 11–24% and PG decreasing by 21–38% across redo TAVI scenarios. Findings demonstrated that leaflet resection improves redo-TAVI valve structural and flow performance by reducing asymmetric mechanical constraint from residual leaflet tissue of the degenerated device. The present computational framework provides a valuable tool to guide the optimization of transcatheter system designed to completely resect and remove degenerated valve leaflets prior to redo TAVI.